scholarly journals Shared Decision Making For Children with Chronic Respiratory Failure- It Takes a Village and a Process

2020 ◽  
Author(s):  
Katharine Kevill ◽  
Grace Ker ◽  
Rina Meyer
Keyword(s):  
Decision Making ◽  
Respiratory Failure ◽  
Shared Decision Making ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Chronic Respiratory Failure ◽  
Shared Decision ◽  
Medical Specialties ◽  
Key Questions

Background and objectives: Shared decision making (SDM) prior to non-urgent tracheostomy in a child with chronic respiratory failure (CRF) is recognized as the standard of care, but has proven challenging to implement in practice. We hypothesize that utilization of the microsystem model for analysis of the complex ecosystem in which SDM occurs will yield insights that enable formation of a reproducible, measurable SDM process. Methods: Retrospective chart review of a case series of children with CRF in whom a SDM process was pursued. The process included a palliative care consult, a validated decision aid and 12 key questions designed to elucidate information integral to an informed decision. Investigators reviewed a single hospital admission for each child, focusing on the 3 core elements of a medical microsystem- the patient, the providers, and information. Results: 29 patients who met inclusion criteria ranged in age from 0 to 19 years (median 1.7) and remained in the hospital from 10 to 316 days (median 38). Patients were medically complex with multiple and varied respiratory diagnoses, multiple and varied comorbidities, and varying psychosocial environments. 14/29 children received tracheostomies. Each child encountered a mean of 6.2 medical specialties, 1.9 surgical specialties and 8.5 non-physician led services. Answers to 12 key questions were not documented systematically and often not found. Conclusion: A unique SDM microsystem is formed around each child but not optimally utilized. Explicit recognition of these microsystems would enable team formation and an SDM process comprised of measurable steps and communication patterns.

scholarly journals Relationship between dementia severity in older women and family caregivers’ preferences for shared decision making about breast cancer screening

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Molly Frank ◽  
Nicole Fowler
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Shared Decision Making ◽  
Family Caregiver ◽  
Standard Of Care ◽  
Shared Decision ◽  
Dementia Severity ◽  
The Relationship

Background/Objective: Mammography is one of the most effective ways to diagnose breast cancer early; however, its perceived benefits are complicated by terminal conditions such as dementia. By undergoing mammography, women with dementia risk treatment complications and false-positive results, which can exacerbate psychological distress. The lack of a standard of care confounds the individual roles of the patient, family caregiver, and physician in the decision-making process. This study evaluates the relationship between dementia severity and family caregiver preferences for shared decision making. Methods: Data were gathered from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) and a revised version of the Control Preferences Scale (CPS) to assess family caregiver preferences for decision-making as a dyad (patient and caregiver) and triad (patient, caregiver, and physician). Two multinomial logistic regression models assessed the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, gender, education, relationship to patient, self-perceived income, and race. Both models used the “active” group as the baseline; however, Model 1 examined preferences as a dyad and Model 2 as a triad. Results: Model 1 found a statistically significant association between dementia severity and a collaborative approach (p<0.001), and between dementia severity and a passive approach (p=0.014). For every one-unit increase in DSRS score, the odds of being in the collaborative group decreased by 0.083 and the odds of being in the passive group decreased by 0.085. There was no statistically significant association between dementia severity and decision-making preferences in Model 2. Clinical Significance: The association between dementia severity and family caregiver decision-making preferences supports the need for a standard of care regarding breast cancer screening in women with dementia.

The Shared Decision-Making Process as the Recommended Standard for Treatment Decisions in Kidney Disease and Requisite Communication Skills to Implement the Process

2020 ◽  
pp. 87-97
Author(s):  
Ernest I. Mandel ◽  
Jane O. Schell ◽  
Robert A. Cohen
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Treatment Decision ◽  
Standard Of Care ◽  
Healthcare Research ◽  
Choosing Wisely ◽  
Decision Making Process ◽  
Shared Decision ◽  
American Society

Shared decision-making (SDM) is the accepted standard of care paradigm for medical decision making between patient or surrogate and clinician. In its Choosing Wisely campaign, the American Society of Nephrology (ASN) recommended SDM prior to the initiation of dialysis. Evidence suggests that SDM enhances patients’ understanding of their illness and satisfaction with the decision-making process, but at present SDM is poorly integrated into dialysis decision-making. Dialysis patients often describe a passive role in the decision to start dialysis, reinforcing the need for implementation of SDM in decision-making with patients with kidney disease. The hallmark feature of SDM is collaboration between the clinician and the patient or surrogate whereby the patient’s expertise in the realm of values and priorities is elicited while the clinician’s medical expertise is shared. The ultimate treatment decision results from the integration of their respective expertise. The Agency for Healthcare Research and Quality SHARE Approach outlines the components of SDM, and frameworks such as the Serious Illness Conversation Guide, REMAP, and SPIRES are roadmaps for those components. Communication tools and mnemonics also facilitate SDM conversations. With knowledge and application of these frameworks and tools, the nephrology community will be better positioned to fulfill the mandate embodied in the ASN Choosing Wisely campaign to employ the SDM process in renal replacement therapy decisions.

scholarly journals Medical informed choice: understanding the element of time to meet the standard of care for valid informed consent

2020 ◽  
Vol 96 (1141) ◽  
pp. 708-710
Author(s):  
Zachary R Paterick ◽  
Timothy Edward Paterick ◽  
Barb Block Paterick
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Outcomes ◽  
Healthcare Providers ◽  
Informed Choice ◽  
Standard Of Care ◽  
Fiduciary Duty ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Legal Principles

Medical informed choice is essential for a physician meeting their fiduciary duty when proposing medical and surgical actions, and necessary for a patient to consent or cull the outlined therapeutic approaches. Informed choice, as part of a shared decision-making model, allows widespread give-and-take of ideas between the patient and physician. This sharing of ideas results in a partnership for decision-making and a responsibility for medical and surgical outcomes.Informed choice is indispensible to the patient education process that meets the desired outcome of any covenant—an offer of and acceptance of the proposed treatment. The covenant anchors a true patient–physician partnership with parity and equality in decision-making and medical/surgical outcomes.Medical informed choice flows from ethical and legal principles necessary to meet the acknowledged standard of care. This is codified by statute and fortified in general common law. This espouses a fiduciary relationship where the patient and physician understand and accede to the degree of autonomy the patient requests.The growth of an equal patient–physician relationship requires time. There is no alternative to the time variable when developing a physician–patient relationship. Despite physicians being under pressures to perform more clinical and administrative duties in less time in the corporate model of medicine, time remains the most critical variable when considering informed choice and shared decision-making. Videos, pamphlets and alternate healthcare providers cannot and should not substitute for physician time.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

On the evaluation of shared decision making: The Decision Evaluation Scales

2004 ◽  
Author(s):  
P. F. M. Stalmeier ◽  
M. S. Roosmalen ◽  
L. C. G. Josette Verhoef ◽  
E. H. M. Hoekstra-Weebers ◽  
J. C. Oosterwijk ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision

Shared Decision Making to Increase Family Involvement in the Care of Consumers With SMI

2013 ◽  
Author(s):  
Shirley M. Glynn ◽  
Lisa Dixon ◽  
Amy Cohen ◽  
Amy Drapalski ◽  
Deborah Medoff ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Family Involvement ◽  
Shared Decision
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